Like a lot of adult children, Roberta Ryan said, “Uh-oh, what are we going to do now?” after her mother fell and broke her hip and wasn't able to return to her apartment.

Ryan's mother was in her 90s, but the family hadn’t done any research into nursing homes.

“The unspoken plan was to keep getting help in her apartment,” Ryan said.

More than one in three people 65 and older will eventually enter a nursing home, according to data cited by the Family Caregiver Alliance. That could be your mother or father — or you.

If you, like many others, haven't done any planning, here are the crucial first steps to take.

how to choose a nursing home where you are most likely to thrive

Paying for a nursing home

The situation: The price of a nursing home in Monroe County averages $112,000 per year, and the average length of stay is 2½ years, according to the state Department of Financial Services. Medicare does not cover long-term residence in a nursing home. People looking for Medicaid coverage need to apply, and the process can be laborious.

Nursing homes have the right to ask financial questions, said Leanne Rorick, program manager for Monroe County for NY Connects, which provides information about long-term services. People need to talk about money with the person they trust to act on their behalf.

What to do: Homes decide whether to admit a person based on several factors. One of those is money. Rorick said that many people don’t like to think of a nursing home as a business, but even a nonprofit facility has to make ends meet.

“If someone doesn’t know what their loved one’s financial situation is, there’s a good chance they might not be admitted because the nursing home doesn’t want to take the risk of admitting someone if they don’t know if they’re going to get paid,” Rorick said.

Nursing homes that are perceived as the better facilities prefer people who will be paying for themselves before they have to rely on Medicaid. Just as flight attendants tell you to put on your own oxygen mask before you help someone else, experts in elder care say to pay yourself first. That could mean having at least $150,000. Home care also is expensive: Just 20 hours a week can run about $21,000 a year.

“So many people want to leave something to their kids,” said Jennifer Meagher, a registered nurse and geriatric care manager who owns Senior Life. “If they have in fact gifted too much money to their children, they didn’t leave enough for themselves and that puts an extra burden on the kids.”

A financial planner or elder law attorney can devise a plan for your situation.

Choosing a nursing home

The situation: Mom or Dad had a crisis that landed them in a hospital, and now they can’t go home. A hospital social worker handed the family paperwork that includes questions about finances and has a list of area nursing homes. The family needs to pick five to 10, and the hospital will see where Mom or Dad can be admitted.

What to do: The process can feel overwhelming, said Kelly Luther, director of social work and patient and family services at Strong Memorial Hospital. The timeframe for when a person has to leave the hospital depends on the individual case, but Luther said it is as soon as possible. Within that short window, family members need to check websites for information about nursing homes and then try to visit some, as well as provide financial information.

Rewind the tape a few months, let alone a few years.

“There’s nothing wrong on your wedding day to start planning,” Meagher said. “But people are so immortal at that age, they don’t want to think about it.”

Nursing homes aren't just for the elderly. Younger people who have illnesses or accidents can need skilled nursing care. Legal documents such as health care proxy, power of attorney and medical orders for life-sustaining treatment can state your wishes when you're not able to speak for yourself. People who’ve put off these decisions while in their 40s and 50s should take care of these items by the time they retire. A financial planner and elder law attorney can help.

Even if a nursing home is not imminent, Ryan suggested asking your loved which one would they want, and then doing research.

Nursing Home Compare, from the Centers for Medicare and Medicaid Services (CMS) provides detailed information about every home that accepts Medicare and Medicaid.

The state Department of Health also provides details about recent inspection reports and other information about homes. The site also has links to other resources.

The Long Term Care Community Coalition has a database on nursing home staffing. Information comes from CMS and, among other things, shows hours of direct care and hours filled by contract workers.

“It is never too early to prepare,” Rorick said. “I’m 48 years old. My list of five favorite nursing homes is at home in my safe. My husband knows that if anything happens to me and I can’t speak for myself, he knows those are my five favorites.”

Advocates say once you’ve read about homes, you should visit at least twice. One visit should be a scheduled tour and another should be an unannounced drop-in.

“If somebody is really serious about finding a qualified organization for their loved one, their first stop should be to make an appointment with administrator to understand how the organization works, what it stands for and what it’s willing to do,” said Loren Ranaletta, president and chief executive officer of Episcopal SeniorLife Communities. “Then I would say if they have doubts after their tour, that’s when I would make an off-hour visit.”

Advocates suggested stopping by on a weekend afternoon, when many residents have visitors and asking them their thoughts about the home.

In separate conversations, Ranaletta and Ryan suggested developing a relationship with the administration, particularly if your loved one is not yet ready for the facility but believes that is the place they’d like to be.

Ryan also urged family members to be honest about their loved one’s personality. “It’s tough being in a nursing home. But we have to remember that not every little old lady is a nice little old lady. I have to give (staff) a bit of a break, too.”

PSINGER@Gannett.com

Do your homework

The following websites have information about all nursing homes in New York.